上方服二剂，漏血即止。惟耳鸣、面浮、自汗犹存。按脉细弱，两寸尤甚。此胸中大气下陷，气分虚极所致，乃易方用张锡纯升陷汤加味。处方：
连服三剂，诸证好转，精神转佳，病告痊愈。
例六：
侯××，女，三十岁，湖南人。患经漏二月余，曾经中西医治疗，而经漏如故，且脐腹绞痛难忍。经用吗啡止痛，收效不大，反而出现口干、舌燥、自汗、发热等症。经其友介绍来诊。症见脉弦细，舌苔白腻少津。结合上述诸症观之，显系血枯化燥，血室瘀热所致。势非攻下，莫可救治。但患者体质虚损，目前用下，恐再伤正气，经漏更甚，必致危殆。宜本“体功重于病邪”之原则。治法分两步，先从健脾养肝，恢复机体功能，待体质好转，方再议下。处方用逍遥散加胡黄连。数剂后，果现脉数，舌转黄燥，发热、自汗。腹痛拒按，大便秘结，数日未解。此瘀热伤津，而肠燥之征象已备，体功已趋好转，下法之条件已具，乃用仲景厚朴七物汤。处方：
方中枳、朴、大黄系小承气汤，用于攻里泻下，并除血室瘀热；桂枝、生姜升肝达郁，肝气得升，则血得归藏而经漏可止；甘草、大枣补益元气而和中。如此组合，既能逐瘀退热，又能安正。
嘱服上方一剂，次日来诊，大为好转，自诉大便已通，下黑粪两次，每次半痰盂之多。且汗止舌润，脉静身凉。两月多来之经漏已随之而止。继以归芍六君汤调理而愈。
此案之主导思想，在于初诊即认定其“正虚邪实”，但不急于驱邪，故先以健脾养肝为第一要着。待患者体气渐充，燥热已趋明显，攻下条件业已成熟，便抓住“血室瘀热是引起经漏不止”这一病机关键所在，毅然投以泻下之法，使瘀热尽除，而收全功。
[按]：崩症系指经血卒然而来，暴下成块，势不可挡，如土崩瓦解，故名曰“崩”。漏症则淋漓不尽，绵延不止，如漏卮难塞，故名曰“漏”。古人认为：“漏者崩之渐，崩者漏之甚”。“久崩不止，气血耗竭，必致成漏，久漏不止，病势日进，亦将成崩。”崩漏二症，虽症状不同，但总由；中任二脉为病。临床诊治必须审其虚实，辨其寒热。故处方用药须根据病情而定。上述病案六例，从中可以看出“同病异治”之灵活性。
经漏血尿
王××，女，四十岁。已婚多年，从未孕育，性多忧郁。1949年春，自感胁腹疼痛，经漏淋漓不已，并发尿血，尿道灼痛。经西医诊断为“子宫肌瘤”，建议手术，未曾施行。经某中医用导赤散、清心莲子饮等方未效，乃请余往诊。按其脉，弦而涩。视其舌，青而滑。病已二月之久，以方衡证，尿血而痛用导赤之类，未为不可，何以不效?因思患者之急欲求医调治者，为求生育也。求而不得，抑郁伤肝，肝藏血，肝气郁结，气血失调，此其因也。今观脉证，确系肝郁。盖厥阴肝脉，“过阴器抵小腹”，故专事清利之导赤散无益也，治劳淋之清心莲子饮亦无济于事。余因之而得到启发，据其主因，不宜从小便之义治。但治经漏何能兼顾尿血?治尿血又怎能顾及经漏?惟既决断为肝郁夹瘀，其病在肝。治宜舒肝解郁。肝气得舒，淋漓可止；肝气不陷，血自归经，尿血可愈。乃处以下方：
此温肝舒郁法也。茯苓、泽泻渗湿利水，杭芍养血柔肝，香附、青皮、玄胡、川楝、郁金，皆调气舒肝之品，亦能活血。砂仁理气通滞。桂枝一味，达木郁以升肝气，张锡纯谓其“善抑肝木之盛，使不横恣”，“又善理肝木之郁使之条达。”
上方服二剂，诸症均有减轻，瘀象亦退。方既已效，仍用原方加减。处方如下：
此在原方基础上，加阿胶养阴益肝，助生地、寸冬养阴润燥，丹皮、焦栀仁化阴生血兼清郁热，血余炭止冲任二脉之血溢下渗；再以苓、泻之渗利湿邪，以桂、芍达郁而平风木。
连服五剂后，各症渐愈，尿血全止，月经调畅。次年受孕而举一子。
[按]：此例之愈，全在“辨证求因，审因论治”。患者年已四十而无嗣，忧虑可知。求子不得，肝气日郁，气血瘀阻，冲任失调，故经漏淋漓。瘀血下注，渗入膀胱，必然尿血。肝血不藏，遂使血不归经，绵缠难愈。治疗之法含舒肝解郁、调理冲任，别无良策。此尚易理解者。如胶柱鼓瑟以“血家禁桂”之说为禁令，则是不深知桂枝之性能与该例尿血之病机。考桂枝辛温，与芍药合用善调气血，与丹皮合用善化厥阴寒凝瘀结。更有妙者，本品善升肝气之下陷，俾冲任和调，血自归经，再佐以育阴润燥之品，何患血之不止!前人虽有“血家禁桂”之论，系指上窍出血之证而言。至于肝气下陷之下窍出血，非但不为禁忌，抑且必用也。故治此类血证，往往加用桂枝，非独此案也。
阴道出血并发紫斑
陈××，女，二十五岁。患阴道出血已三周，兼见全身紫斑。住某医院中西医结合治疗，中药曾用过犀角地黄汤、牛黄丸等多剂，阴道出血不仅未止，又增齿龈出血、鼻衄。转余诊治。症见：面色苍白，两颊微红，舌质淡，苔薄白少津，脉芤。此血不循经脉运行而溢予外也，即所谓“血不归经”。其所以不归经者，殆由阴虚阳浮使然，故现鼻衄、齿衄及紫斑等出血现象。前医药过寒凉，正气受损，故出血不止。今本“急则治标”之原则，先以止血为务。然此证虽属阴血虚亏，但热象并不显著，用药不可过寒，寒则凝，易留瘀；亦不可过热，热则动血，更不易止。宜寒温并用，刚柔相济为适当。乃用自拟方生地侧柏叶汤加白茅根。处方：
此方说明见本书“鼻衄”例一。
服药三剂，出血顿止，紫斑未全退。继用自拟方二甲化斑汤。处方：
方中二甲(龟板、牡蛎)育阴潜阳，沙参养阴润肺；玄参滋水润燥，又清浮越之火，阿胶滋阴补血，茜草、蒲黄炭、藕节凉血止血，活血祛瘀；甘草护胃和中，牛膝引诸药下行。全方组合，滋阴潜阳，止血消瘀。 连服五剂诸症消失。
胎
漏
李××，女，三十一岁。曾流产三次，现怀孕三周又有漏血，颜色淡红，淋漓不止。兼见腰脊酸痛。舌红润，苔薄白，脉沉弱。此属气血不足，冲任不固。治宜调补气血以增强冲任。先用仲景胶艾四物汤加减。处方：
此方，以四物汤去川芎加参、芪补血养血；合以阿胶、炙艾则能固经止血，加苎麻根之凉血止血而安胎；又得炮姜、甘草之苦甘化阴而滋血，则胎元可固，流血可止。
连服三剂，漏血止。继以已故成都名中医陈焕甫治习惯性流产之名方“保产丸” (改汤剂)加减调理，以资巩固。方用：
方中菟丝、寄生补肾强腰，固肾安胎，续断、杜仲补肝肾强腰膝而保胎，黄芪、党参补益气血而固胎；阿胶滋补肾阴，益血养胎；砂仁行滞气，并防补药之滋腻碍胃。如此组合，功能补肾气，益气血，使肾气足，气血充，则冲任固而胎自安。嘱每周眼三付，隔日一付，连服一月。于是，胎得以安，届期顺利分娩，母子平安。
[按]：妇人胎漏，系指怀孕后阴道有不规则之流血或点滴漏下或淋漓不止等现象，又叫胞漏或漏胎。若不急止其血，则胎元受损，甚至引起流产或小产。本证多因妊妇气血亏虚，冲任不固所致，亦有因血热、房室不节、跌仆损伤所致者。应根据不同情况辨证用药。胶艾四物汤合炮姜甘草汤加苎麻根为治疗一般胎漏之方。气虚明显者加参、苠，有血热现象者加黄芩、地榆，跌仆损伤者，加续断、骨碎补。并告以力戒房事，则疗效颇佳。本方叉能补血，血足则胎得所养。本例因有流产史，故血止后，继用保产丸加减，以补肾固冲。
又：本方适应范围较广，尚可用于胎位不正等症。
产后发热三例
例一：
李××，女，三十岁。产后发热，面色赤，神倦，头痛、眩晕，项强，恶寒、肢冷，腰疫，微喘。舌淡润，苔白，脉浮弦无力。此系产后里虚，外感风寒所致。治宜扶正祛邪，表里兼治。方用《金匮要略》竹叶汤。处方；
此方为产后里虚有表邪的正治方。产后兼表，尤在泾说：“若攻其表，则气浮易脱；若补其里，则表多不服。”上方乃表里兼顾法也。
服一剂，热退身凉，再剂即愈。
此案竹叶汤一方，载《金匮要略·妇人产后病脉证治第二十一》，原文曰：“产后中风，发热，面正赤，喘而头痛，竹叶汤主之。”产后中风(此指外感风邪)，发热头痛，为感受表邪。面赤气喘为虚阳上浮。此表有外邪，里有气虚和虚阳不敛，为正虚邪实，即虚中夹实证。仲景采用扶正祛邪法，药证相符，丝丝入扣。但《张氏医通》认为，方中附子与证不合，疑为错简，因而把它删掉，可能是把面赤误认为热证。这种面赤是真寒假热，类似戴阳证。若不用附子，何能收敛浮阳。附子配人参即参附汤，有回阳固脱之功。此二味合用，正针对里气虚馁、虚阳上浮而设。此方经数十年临床验证，从未去附子，都收到预期的效果。说明此方用附子并非虚设。
又：方中竹叶有两种，原方未注明用何种。余用淡竹叶，属禾本科多年生草本植物的茎叶，功能清热、利尿、散风热，配解表药有退热作用。另一种竹叶为禾本科苦竹，属常绿苞木的鲜叶，功能内熄肝胆之风，外清暑湿之热，又能安神止痉。两种科属效用不同，用时宜加区别。
例二：
杨××，女，三十岁。产后感冒，延余往诊。症见：头痛，恶寒、微热。舌质淡，苔薄白，脉浮缓。此产后血虚，感受外邪所致。治宜养血解表。用自拟方加减愈风散。处方。
此方用于产后血虚，外感风寒之证。方中炒荆芥轻散血中风寒，当归、黑豆养肝和血，再加独活散肾经伏风，并佐荆芥以增强祛风之力。
此案加减愈风散一方，由华佗愈风散和后世当归散变化而来。因善治产后风邪为患，仍定名“愈风散”。二方俱载于《中国医学大辞典》。愈风散“治一切失血，筋脉紧急，汗后搐搦，妇人产后中风口噤，手足瘼疭，角弓反张，或血晕不省人事，四肢强直……”。药用荆芥穗微炒，研为细末。每服三、五钱，豆淋酒或童便调下。当归散由当归、荆芥组成，“治产后中风，牙关紧闭，不省人事，口吐涎沫，手足瘈疭”。合二方为一方，并加独活一味，用治产后血虚，外感风寒之症。经数十年临床实践，效果良好。
例三：
孟××，女，三十七岁，体质素健。于1949年春分娩后，高热持续不退，前医曾用养肝补血药多剂，热势依然。延至月余，热势更张，时有神昏、谵语，病情危殆，求余诊治。症见；脉洪大，重按有力，舌苔白燥，面垢自汗，烦渴饮冷，手足不时厥冷，面部微浮，四肢轻度肿胀。细询：病情，始知病由外感失治，又加滋补所致。脉症合参，病属燥热伤阴，肺胃火郁而发热，乃里热亢盛之征。然病在产后，极易与“血虚发热”相混淆。若辨认不清，毫厘之差，．即千里之谬，生死立见于反掌之间，自应明辨慎思，方不致误。血虚发热，有时证似白虎，亦有发热面赤，烦渴、汗出等症。但脉象多见细数，而少洪大，舌质多淡自。虽有自汗、烦渴，但不引饮。患者倘系血虚发热，则前所用养肝补血之剂，理应见效。今不效者，足征发热并非里虚。今自虎确证已具，自当以甘寒退热之白虎汤施治。但古人有“石膏为产后禁忌”之说。且产后三大症，以麻仁丸治便秘，小柴胡汤治郁冒，竹叶汤治风痉。并无白虎汤为治之设。经反复思索，并忆及徐灵胎用石膏治愈西濛陆炳若夫人产后风热之例，结合本症病情，若因循再用补益，而不速投甘寒退热之剂，则阳明独盛，不免导致阳盛阴亡之虞。患者虽在产后，但脉证俱实。遵仲景“观其脉证，知犯何逆，随证治之”的启示，决定用张锡纯白虎加人参，以山药代粳米汤。处方：
After taking two doses of the above prescription, the vaginal bleeding stopped immediately. However, tinnitus, facial edema, and spontaneous sweating persisted. The pulse was fine and weak, particularly at both Cun positions. This indicates a sinking of the Grand Qi in the chest due to extreme deficiency of the Qi aspect. Therefore, the prescription was changed to Zhang Xichun's Shengxian Tang (Ascending the Sinking Decoction) with modifications. The prescription is as follows:
Beihuangqi (Astragali Radix) 24g, Zhimu (Anemarrhenae Rhizoma) 9g, Shengma (Cimicifugae Rhizoma) 6g, Chaihu (Bupleuri Radix) 6g, Jiegeng (Platycodonis Radix) 6g;
Shanyurou (Corni Fructus) 9g, Ludangshen (Codonopsis Radix) 15g.
After three consecutive doses, all symptoms improved, mental spirit recovered, and the disease was cured.
Case 6:
Hou XX, female, 30 years old, from Hunan. She suffered from Jinglou (metrorrhagia) for over two months. Despite treatment by both Western and Chinese medicine, the metrorrhagia continued, accompanied by unbearable cramping pain in the umbilical and abdominal regions. Morphine was used for pain relief with little effect, instead causing dry mouth, dry tongue, spontaneous sweating, and fever. Introduced by a friend, she came for consultation. Her symptoms included a wiry and fine pulse, and a white, greasy tongue coating with scant fluid. Considering these symptoms, it is clearly caused by blood exhaustion leading to dryness, and stasis-heat in the Blood Chamber (Uterus). The condition requires purgation to be saved. However, the patient's constitution is deficient. Using purgation now might further damage the Healthy Qi (Zheng Qi), worsen the metrorrhagia, and lead to critical danger. It is necessary to follow the principle that "the body's functional capacity is more important than the pathogenic factor." The treatment should be divided into two steps: first, strengthen the Spleen and nourish the Liver to restore bodily functions; once the constitution improves, consider purgation. The prescription used Xiaoyao San (Free and Easy Wanderer Powder) with Huhuanglian (Picrorhizae Rhizoma). After several doses, her pulse became rapid, the tongue turned yellow and dry, and she experienced fever and spontaneous sweating. Abdominal pain was aggravated by pressure, and stool was constipated for several days. This indicates that stasis-heat has damaged fluids, and intestinal dryness is evident. The body's functional capacity has improved, and the conditions for purgation are met. Thus, Zhang Zhongjing's Houpo Qiwu Tang (Magnolia Bark Seven-Ingredient Decoction) was used. The prescription is as follows:
Chuanhoupo (Magnoliae Officinalis Cortex) 9g, Zhishi (Aurantii Fructus Immaturus) 9g, Dahuang (Rhei Radix et Rhizoma) 9g, Guizhi (Cinnamomi Ramulus) 9g, Gancao (Glycyrrhizae Radix et Rhizoma) 9g;
Shengjiang (Zingiberis Rhizoma Recens) 3 slices, Dazao (Jujubae Fructus) 3 pieces.
In this formula, Zhishi, Houpo, and Dahuang constitute Xiao Chengqi Tang (Minor Order the Qi Decoction), used to purge the interior and clear stasis-heat in the Blood Chamber; Guizhi and Shengjiang ascend Liver Qi and resolve stagnation; when Liver Qi ascends, blood returns to its storage, stopping metrorrhagia; Gancao and Dazao tonify Yuan Qi and harmonize the Middle Jiao. This combination eliminates stasis and reduces heat while stabilizing the Healthy Qi.
She was instructed to take one dose. She returned the next day with significant improvement, reporting passage of black stool twice, half a chamber pot each time. Sweating stopped, the tongue became moist, the pulse calmed, and body temperature normalized. The metrorrhagia lasting over two months also ceased. She was subsequently treated with Guishao Liujun Tang (Guizhi, Shaoyao, and Six-Gentlemen Decoction) for regulation and recovery.
The guiding thought of this case was recognizing "Healthy Qi deficiency and pathogenic excess" at the initial visit but not rushing to expel pathogens. Instead, strengthening the Spleen and nourishing the Liver was prioritized. Once the patient's vital energy increased and dryness-heat became obvious, and conditions for purgation were ripe, the key pathogenesis—"stasis-heat in the Blood Chamber causing persistent metrorrhagia"—was addressed decisively with purgation, eliminating stasis-heat completely and achieving full recovery.
[Commentary]: Bengzheng (Sudden heavy bleeding) refers to sudden, massive menstrual bleeding with clots, unstoppable like a collapsing earth, hence named "Beng". Louzheng (Dripping bleeding) refers to continuous, dripping bleeding that never stops, like a leaking vessel, hence named "Lou". Ancients believed: "Lou is the beginning of Beng, Beng is the severity of Lou." "Prolonged uncontrolled Beng depletes Qi and Blood, inevitably leading to Lou; prolonged uncontrolled Lou advances the disease, eventually becoming Beng." Although Beng and Lou have different symptoms, they both originate from disorders of the Chong and Ren meridians. Clinical diagnosis must distinguish deficiency/excess and cold/heat. Prescriptions must be tailored to the condition. The six cases above demonstrate the flexibility of "treating the same disease differently."
Metrorrhagia with Hematuria
Wang XX, female, 40 years old. Married for many years without conception, prone to depression. In spring 1949, she felt hypochondriac and abdominal pain, continuous dripping metrorrhagia, hematuria, and burning pain in the urethra. Diagnosed with "uterine fibroids" by Western medicine, surgery was suggested but not performed. Treatment with Daochi San (Guide Out Red Powder) and Qingxin Lianzi Yin (Clear Heart Lotus Seed Decoction) by another TCM practitioner failed. I was consulted. The pulse was wiry and choppy. The tongue was bluish-green and slippery. The illness had lasted two months. Using Daochi-type formulas for painful hematuria seems appropriate, yet why did it fail? I considered that the patient's urgent desire for medical treatment was to achieve pregnancy. Failure to conceive led to depression injuring the Liver. The Liver stores Blood; Liver Qi stagnation causes Qi-Blood disharmony, which is the cause. Current pulse and symptoms confirm Liver Qi stagnation. The Jueyin Liver meridian "passes through the genitalia and reaches the lower abdomen." Therefore, purely clearing and draining formulas like Daochi San are ineffective, and Qingxin Lianzi Yin for labor dysuria is also useless. Inspired by this, based on the main cause, treatment should not focus solely on urination. But how can treating metrorrhagia address hematuria? And vice versa? Since it is determined as Liver Qi stagnation with blood stasis, the pathology lies in the Liver. Treatment should soothe the Liver and resolve stagnation. When Liver Qi is soothed, dripping stops; when Liver Qi does not sink, blood returns to its vessels, curing hematuria. The following prescription was given:
Baifuling (Poria) 15g, Chao Zexie (Alismatis Rhizoma) 6g, Guizhi (Cinnamomi Ramulus) 9g, Chao Hangshao (Paeoniae Radix Alba) 9g;
Zhi Xiangfu (Cyperi Rhizoma) 9g, Sharen (Amomi Fructus) 6g, Yujin (Curcumae Longae Radix) 6g, Qingpi (Citri Reticulatae Pericarpium Viride) 9g, Yanhusuo (Corydalis Rhizoma) 9g;
Chuanlianzi (Meliae Fructus) 6g, Gancaoshao (Glycyrrhizae Radix et Rhizoma tip) 4.5g.
This is a method to warm the Liver and soothe stagnation. Fuling and Zexie promote dampness drainage and diuresis; Hangshao nourishes Blood and softens the Liver; Xiangfu, Qingpi, Yanhusuo, Chuanlianzi, and Yujin regulate Qi, soothe the Liver, and invigorate Blood; Sharen regulates Qi and unblocks stagnation. Guizhi resolves Wood stagnation and ascends Liver Qi. Zhang Xichun stated it "excels at suppressing excessive Liver Wood to prevent rampant behavior" and "also excels at resolving Liver Wood stagnation to make it flow smoothly."
After two doses of the above prescription, all symptoms decreased, and stasis signs receded. Since the formula was effective, the original prescription was modified. The new prescription is as follows:
Baifuling (Poria) 15g, Chao Zexie (Alismatis Rhizoma) 6g, Guizhi (Cinnamomi Ramulus) 9g, Chao Hangshao (Paeoniae Radix Alba) 9g;
Ejiao (Colla Corii Asini) 9g, Shengdi (Rehmanniae Radix) 12g, Danpi (Moutan Cortex) 6g, Jiao Zhiren (Gardeniae Fructus) 6g, Zhe Cundong (Ophiopogonis Radix) 9g;
Sheng Gancao (Glycyrrhizae Radix et Rhizoma) 4.5g, Xuyutuan (Hominis Pilus Carbonisatus) one ball.
Based on the original formula, Ejiao was added to nourish Yin and benefit the Liver, assisting Shengdi and Cundong in nourishing Yin and moistening dryness; Danpi and Jiao Zhiren transform Yin to generate Blood and clear stagnant heat; Xuyutuan stops bleeding from the Chong and Ren meridians; Fuling and Zexie drain dampness; Guizhi and Shaoyao resolve stagnation and calm Wind-Wood.
After five consecutive doses, symptoms gradually resolved, hematuria stopped completely, and menstruation became regular. She conceived the following year and gave birth to a son.
[Commentary]: The cure of this case relied entirely on "differentiating syndromes to seek the cause, and treating according to the cause." The patient was forty and childless, implying great anxiety. Inability to conceive led to daily Liver Qi stagnation, Qi-Blood stasis, and Chong-Ren disharmony, causing dripping metrorrhagia. Stasis blood flowed downward, infiltrating the bladder, inevitably causing hematuria. Liver Blood failing to store resulted in blood not returning to its vessels, making healing difficult. The treatment method involves soothing the Liver, resolving stagnation, and regulating Chong-Ren, with no other good strategy. This is easy to understand. However, rigidly adhering to the taboo "Blood disorders contraindicate Guizhi" shows a lack of understanding of Guizhi's properties and this case's hematuria pathogenesis. Guizhi is acrid and warm; combined with Shaoyao, it regulates Qi and Blood well; combined with Danpi, it transforms Jueyin cold-stagnation and stasis. More importantly, it excels at ascending sunken Liver Qi, harmonizing Chong-Ren, allowing blood to return to its vessels. Assisted by Yin-nourishing and moistening agents, why worry about uncontrolled bleeding! Although predecessors mentioned "Blood disorders contraindicate Guizhi," this referred to upper orifice bleeding. For lower orifice bleeding due to sunken Liver Qi, it is not only not contraindicated but essential. Thus, Guizhi is often added for such blood disorders, not just in this case.
Vaginal Bleeding Complicated by Purpura
Chen XX, female, 25 years old. Had vaginal bleeding for three weeks, accompanied by generalized purpura. Admitted to a hospital for integrated Chinese and Western medicine treatment. Multiple doses of Xijiao Dihuang Tang (Rhino Horn and Rehmannia Decoction) and Niuhuang Wan (Calculus Bovis Pill) were used. Vaginal bleeding did not stop; gingival bleeding and epistaxis (nosebleed) were added. Consulted me. Symptoms: pale complexion, slightly red cheeks, pale tongue body, thin white scanty coating, Koubu (Empty) pulse. This is blood overflowing outside because it does not follow the meridians, known as "Blood not returning to its vessels." The reason for not returning to vessels is likely Yin deficiency with floating Yang, causing epistaxis, gingival bleeding, and purpura. Previous medication was too cold, damaging Healthy Qi, thus bleeding did not stop. Following the principle of "emergency treatment focuses on symptoms," hemostasis is the priority. Although this syndrome belongs to Yin-Blood deficiency, heat signs are not prominent. Medication should not be too cold, as cold causes coagulation and leaves stasis; nor too hot, as heat moves blood and makes it harder to stop. Cold and warm herbs should be used together, balancing rigid and soft properties. A self-formulated formula, Shengdi Cebaiye Tang (Rehmannia and Biota Top Decoction) plus Baimaogen (Imperatae Rhizoma) was used. The prescription is as follows:
Shengdi (Rehmanniae Radix) 15g, Cebaiye (Biota Tops) 9g, Baimaogen (Imperatae Rhizoma) 9g, Maidong (Ophiopogonis Radix) 9g, Hangshao (Paeoniae Radix Alba) 9g;
Zhi Aiye (Artemisiae Argyi Folium) 6g, Oujie (Nelumbinis Node) 5 pieces, Paojiang (Zingiberis Rhizoma Preparatum) 15g, Zhi Gancao (Glycyrrhizae Radix et Rhizoma) 6g.
Explanation of this formula is found in Case 1 of "Epistaxis" in this book.
After three doses, bleeding stopped abruptly, but purpura did not fully fade. Subsequently, a self-formulated formula, Erjia Huaban Tang (Two Shells Spot-Resolving Decoction) was used. The prescription is as follows:
Zhi Guiban (Testudinis Carapax et Plastrum) 15g, Sheng Muli (Concha Ostreae) 15g, Shashen (Glehniae Radix) 9g, Xuanshen (Scrophulariae Radix) 9g, Ejiao (Colla Corii Asini) 15g;
Qiancao (Rubiae Radix et Rhizoma) 6g, Oujie (Nelumbinis Node) 3 pieces, Niuxi (Achyranthis Bidentatae Radix) 9g, Gancao (Glycyrrhizae Radix et Rhizoma) 3g, Puhuang (Typhae Pollen) 6g (vinegar-fried).
In this formula, Erjia (Guiban, Muli) nourishes Yin and anchors Yang; Shashen nourishes Yin and moistens the Lung; Xuanshen moistens water and dries, clearing floating fire; Ejiao nourishes Yin and tonifies Blood; Qiancao, Puhuang Tan, and Oujie cool Blood, stop bleeding, invigorate Blood, and remove stasis; Gancao protects the Stomach and harmonizes the Middle; Niuxi guides the herbs downward. The entire formula combines to nourish Yin, anchor Yang, stop bleeding, and eliminate stasis. After five consecutive doses, all symptoms disappeared.
Fetal Leakage
Li XX, female, 31 years old. Had three miscarriages. Now pregnant for three weeks, experiencing leakage of light red blood, dripping continuously. Accompanied by soreness and pain in the waist and spine. Tongue is red and moist, coating thin white, pulse deep and weak. This belongs to Qi and Blood insufficiency, with insecure Chong and Ren meridians. Treatment should regulate and tonify Qi and Blood to strengthen Chong and Ren. First, use Zhang Zhongjing's Jiao'ai Siwu Tang (Donkey-Hide Gelatin and Four-Substance Decoction) with modifications. The prescription is as follows:
Shengdi (Rehmanniae Radix) 15g, Danggui (Angelicae Sinensis Radix) 15g, Ludangshen (Codonopsis Radix) 15g, Kouqi (Astragali Radix) 15g, Hangshao (Paeoniae Radix Alba) 9g;
Ejiao (Colla Corii Asini) 15g, Zhi Aiye (Artemisiae Argyi Folium) 9g, Paojiangtan (Zingiberis Rhizoma Preparatum Carbonisatum) 15g, Zhi Gancao (Glycyrrhizae Radix et Rhizoma) 6g, Zhumaegen (Ramie Root) 9g.
This formula uses Siwu Tang removing Chuanxiong, adding Renshen and Huangqi to tonify and nourish Blood; combined with Ejiao and Zhi Aiye to secure menstruation and stop bleeding; adding Zhumaegen to cool Blood, stop bleeding, and calm the fetus; obtaining Paojiang and Gancao's bitter-sweet transformation to Yin to nourish Blood, securing the fetal origin and stopping bleeding.
After three consecutive doses, leakage stopped. Subsequently, modifications of the famous formula "Baochan Wan" (Protect Birth Pill) by the late renowned Chengdu TCM physician Chen Huanfu (converted to decoction) were used for regulation to consolidate. The formula uses:
Tusizi (Cuscutae Semen) 15g, Xuduan (Dipsaci Radix) 9g, Sangjisheng (Taxilli Herba) 15g, Ludangshen (Codonopsis Radix) 15g;
Duzhong (Eucommiae Cortex) 15g, Kouqi (Astragali Radix) 15g, Ejiao (Colla Corii Asini) 15g, Sharen (Amomi Fructus) 3g.
In this formula, Tusizi and Sangjisheng tonify Kidney and strengthen the waist, secure Kidney and calm the fetus; Xuduan and Duzhong tonify Liver and Kidney, strengthen waist and knees, and protect the fetus; Huangqi and Dangshen tonify Qi and Blood to secure the fetus; Ejiao nourishes Kidney Yin and benefits Blood to nourish the fetus; Sharen moves stagnant Qi and prevents cloying nature of tonics from obstructing the Stomach. This combination functions to tonify Kidney Qi, benefit Qi and Blood. When Kidney Qi is sufficient and Qi and Blood are abundant, Chong and Ren are secured, and the fetus is naturally calm. Instructed to take three doses per week, every other day, for one month. Thus, the fetus was secured, and she delivered smoothly at term, mother and child safe.
[Commentary]: Fetal leakage in women refers to irregular vaginal bleeding, spotting, or continuous dripping after pregnancy, also called Baolou or Lotai. If bleeding is not stopped urgently, the fetal origin is damaged, potentially causing miscarriage or premature delivery. This syndrome is mostly caused by Qi and Blood deficiency of the pregnant woman and insecurity of Chong and Ren meridians, but can also be caused by Blood heat, sexual indiscretion, or falls/injuries. Medication should be differentiated according to different situations. Jiao'ai Siwu Tang combined with Paojiang Gancao Tang plus Zhumaegen is a formula for general fetal leakage. For obvious Qi deficiency, add Renshen and Huangqi; for Blood heat signs, add Huangqin and Diyü; for falls/injuries, add Xuduan and Gusuibu. Advise strict avoidance of sexual intercourse for good efficacy. This formula also tonifies Blood; sufficient Blood nourishes the fetus. This case had a history of miscarriage, so after bleeding stopped, modifications of Baochan Wan were used to tonify Kidney and secure Chong.
Furthermore: This formula has a wide range of indications and can also be used for malpresentation.
Three Cases of Postpartum Fever
Case 1:
Li XX, female, 30 years old. Postpartum fever, red face, mental fatigue, headache, vertigo, stiff neck, aversion to cold, cold limbs, sore waist, slight panting. Tongue pale and moist, white coating, floating wiry and weak pulse. This is postpartum interior deficiency with external contraction of Wind-Cold. Treatment should support Healthy Qi and expel pathogens, treating both exterior and interior. Use Zhuye Tang (Bamboo Leaf Decoction) from *Jin Gui Yao Lue*. The prescription is as follows:
Fupian (Aconiti Lateralis Radix Preparata) 60g, Dan Zhuye (Lophatheri Herba) 9g, Gegen (Puerariae Lobatae Radix) 9g, Fangfeng (Saposhnikoviae Radix) 9g, Jiegeng (Platycodonis Radix) 6g;
Ludangshen (Codonopsis Radix) 15g, Guizhi (Cinnamomi Ramulus) 9g, Gancao (Glycyrrhizae Radix et Rhizoma) 6g, Shengjiang (Zingiberis Rhizoma Recens) 9g, Dazao (Jujubae Fructus) 3 pieces.
This formula is the standard treatment for postpartum interior deficiency with exterior pathogens. Regarding postpartum exterior involvement, You Zaijing said: "If attacking the exterior, Qi floats and easily collapses; if tonifying the interior, the exterior often becomes uncomfortable." The above formula is a method treating both exterior and interior.
After one dose, fever subsided and body cooled; after two doses, she was cured.
This Zhuye Tang formula is recorded in *Jin Gui Yao Lue · Chapter 21: Pulse, Syndrome, and Treatment of Diseases after Childbirth*, stating: "Postpartum wind-stroke, fever, bright red face, panting and headache, Zhuye Tang governs it." Postpartum wind-stroke (here referring to external Wind-Evil), fever and headache indicate contracting exterior pathogens. Bright red face and panting indicate floating deficient Yang. Exterior has external pathogens, interior has Qi deficiency and unconstrained deficient Yang, representing Healthy Qi deficiency with pathogenic excess, i.e., deficiency mixed with excess. Zhang Zhongjing adopted the method of supporting Healthy Qi and expelling pathogens, matching medicine to syndrome precisely. However, *Zhang Shi Yi Tong* considered Fuzi in the formula inconsistent with the syndrome, suspected it as a textual error, and deleted it, possibly mistaking the red face for a heat syndrome. This red face is true cold with false heat, similar to Daiyang syndrome (floating Yang). Without Fuzi, how can floating Yang be constrained? Fuzi paired with Renshen forms Shenfu Tang (Ginseng and Aconite Decoction), having the function of restoring Yang and securing collapse. These two ingredients combined precisely target interior Qi deficiency and floating deficient Yang. This formula has been verified clinically for decades without removing Fuzi, always achieving expected results. This shows Fuzi in this formula is not superfluous.
Furthermore: There are two types of Zhuye in the formula, unspecified originally. I use Dan Zhuye, stems and leaves of a perennial herbaceous plant in the Poaceae family, functioning to clear heat, promote diuresis, and scatter Wind-Heat, having antipyretic effects when paired with exterior-releasing drugs. The other type is fresh leaves of Phyllostachys nigra var. henonis (Kuzhu), evergreen shrubs in Poaceae, functioning internally to extinguish Liver/Gallbladder Wind, externally to clear Summerheat-Dampness, and also calming the Spirit and stopping spasms. The two families have different effects; distinction is needed during use.
Case 2:
Yang XX, female, 30 years old. Caught a cold after childbirth, consulted me. Symptoms: headache, aversion to cold, slight fever. Tongue pale, thin white coating, floating moderate pulse. This is postpartum Blood deficiency with external pathogen contraction. Treatment should nourish Blood and release the exterior. Use self-formulated Jiajian Yufeng San (Modified Wind-Dispelling Powder). The prescription is as follows:
Danggui (Angelicae Sinensis Radix) 15g, Heidou (Sojae Semen Nigrum) 6g, Chao Jingjie (Schizonepetae Spica) 6g, Duhuo (Angelicae Pubescentis Radix) 6g.
This formula is used for postpartum Blood deficiency with external Wind-Cold contraction. In the formula, fried Jingjie lightly disperses Wind-Cold in the Blood; Danggui and Heidou nourish Liver and harmonize Blood; adding Duhuo disperses latent Wind in the Kidney meridian, assisted by Jingjie to enhance wind-dispelling power.
This Jiajian Yufeng San formula evolved from Hua Tuo's Yufeng San and later Danggui San. Because it treats postpartum Wind-Evil well, it retains the name "Yufeng San." Both formulas are recorded in *Chinese Medical Dictionary*. Yufeng San "treats all hemorrhages, tendon/muscle tension, convulsions after sweating, postpartum wind-stroke with locked jaw, limb spasms, opisthotonos, or blood syncope with unconsciousness, limb rigidity..." Medicine: Jingjie Spica lightly fried, ground to fine powder. Take 3-5 qian each time, mixed with Doulin Jiu (Bean-soaked Wine) or Tongbian (Child's Urine). Danggui San consists of Danggui and Jingjie, "treating postpartum wind-stroke, locked jaw, unconsciousness, foaming at mouth, limb spasms." Combining two formulas into one, adding Duhuo, used for postpartum Blood deficiency with external Wind-Cold. Decades of clinical practice show good effects.
Case 3:
Meng XX, female, 37 years old, generally healthy constitution. After delivery in spring 1949, high fever persisted. Previous doctors used multiple doses of Liver-nourishing and Blood-tonifying medicines, but fever remained. Over a month later, fever intensified, with occasional confusion and delirium, critical condition, consulted me. Symptoms: surging large pulse, strong upon heavy pressure, white dry tongue coating, dirty face with spontaneous sweating, irritability and thirst for cold drinks, intermittent cold extremities, slight facial swelling, mild limb swelling. Detailed inquiry revealed the illness resulted from untreated external contraction plus excessive tonification. Pulse and symptoms combined indicate Dryness-Heat damaging Yin, Lung/Stomach Fire stagnation causing fever, signs of intense interior heat. However, being postpartum, it is easily confused with "Blood deficiency fever." If not distinguished clearly, a slight difference leads to a thousand-mile error; life and death depend on a moment's decision. One must differentiate carefully to avoid mistakes. Blood deficiency fever sometimes resembles Baihu Tang syndrome, with fever, red face, irritability/thirst, sweating. But pulse is usually fine and rapid, rarely surging large; tongue is usually pale and white. Although there is spontaneous sweating and irritability/thirst, there is no desire to drink. If the patient had Blood deficiency fever, previous Liver-nourishing and Blood-tonifying agents should have worked. The fact they didn't proves fever is not interior deficiency. Now Baihu Tang syndrome evidence is complete; one should treat with sweet-cold cooling Baihu Tang. But ancients said "Shigao (Gypsum) is contraindicated postpartum." Also, the three major postpartum syndromes are treated with Mahuang Wan for constipation, Xiao Chaihu Tang for depression/dizziness, and Zhuye Tang for wind-spasm. There is no mention of Baihu Tang for treatment. After repeated reflection, recalling Xu Lingtai using Shigao to cure Mrs. Lu Bingruo's postpartum Wind-Heat, combined with this case's condition, if one continues tonifying without quickly administering sweet-cold cooling agents, Yangming will dominate alone, risking Yang excess and Yin exhaustion. Although postpartum, pulse and symptoms are both excess. Following Zhang Zhongjing's inspiration "Observe pulse and syndrome, know what deviation occurred, treat according to syndrome," decided to use Zhang Xichun's Baihu Jia Renshen Tang (White Tiger Plus Ginseng Decoction) with Shanyao replacing Jingmi (Rice). The prescription is as follows:
Sheng Shigao (Gypsum Fibrosum) 15g (crushed, decocted first), Ludangshen (Codonopsis Radix) 15g, Chao Zhimu (Anemarrhenae Rhizoma) 9g;
Sheng Gancao (Glycyrrhizae Radix et Rhizoma) 6g, Huai Shanyao (Dioscoreae Rhizoma) 15g.